460 Recipient Committee Campaign Statement/Termination 12-31-2009 ecipientCommittee
Campaign Statement
Cover Page
(Government Code Sections 84200.84216.5)
Type or print In Ink
Statement covers period
from 07/01/2009
SEE INSTRUCTIONS ONREVERSE
through 12/31/2009
1. Type of Recipient Committee: All CommHteea -Complete PaAs 1, 2, a, and a.
^x Officeholder, Candidate Controlled Committee ^ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
Q Recall Q Controlled
(asoconpbroPertsl Q Sponsored
(aaoComplefePede)
^ General Purpose Committee
Q Sponsored ^ Primarily Formed Candidate)
QSmaIlContributorCommittee Officeholder Committee
QPoliticalPartylCentralCommittee (NaroComplefePadlJ
3. Committee Information
COMMITTEE
NAME IF NO COMMITTEE)
I.D. NUMBER
990781
Dolly Sandoval for Supervisor-Debt Retirement Committee
STREET ADDRESS (NO P,O. BOX)
10720 Alderbrook Lane
CITY STATE ZIP CODE AREA CODEIPHONE
ADDRESS (IF DIFFERENT)
CA 95019
CITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX I EMAIL ADDRESS
Date of election If
(Month, Day,
2. Type of Statement:
of 7
COVERPAGE
NO ~~~ ~~^~~ I For Official Use Onty
^ PreelecfionStatement
(~ Semi-annual Statement
^x Termination Statement
(Also file a Form 410 Termination)
^ Amendment (Explain below)
^ Quarterly Statement
^ Special Odd-Year Report
^ Supplemental Preelection
Statement-Attach Form 495
Treasurer(s)
NAME OF TREASURER
Me. Dolly Sandoval
MAILING ADDRESS
10720 Alderbrook Lane,
CITY STATE ZIP CODE AREA CODEIPHONE
Cupertino CA 95014 (408) 725-8936_.
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE 21P CODE AREA CODEIPHONE
OPTIONAL: FAX I EMAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is free and complete. I certify
under penalty oiperjury under the I~ws ofthe State of California that the foregoing is h
Executed on ~ I ~~ I ~~ 1 V BY
D. to
Executed on ~ ~~ ~~ ~ BY
Executed on Dale BY SignalureofConUdGngOficeholder,Candidals,S~steMeasueProporreM
Fxecutedon Dale BY SignelureolCoMrdMgOfficehdder,Cendidete,StNeMeesureProponsM
FPPC Form 460 (Januaryal6)
FPPC Toll•Free Helpllne: 8661ASK•FPPC (8661275)772)
State of California
FEB -12010
ype or print in ink.
Recipient Committee
Campaign Statement
Cover Page -Part 2
6. Primarily Formed Ballot Measure Committee
Page 2 of 1
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Dolores (Dolly) Sandoval
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESSRDDRESS (N0. AND STREET) CITY STATE ZIP
10120 Alderbrook Lane,
Cupertino CA 95014
Related Committees Not Included in this Statement: List any committees
not Included in this statement that are controlled by you or are primarily /ormed to receive
contributions or make expenditures on behalf of your candidacy,
COMMITTEENAME (( LD. NUMBER
. - . ., - ~ ~ •- ~ I L ~ r l
NAMEOFTREASURER ICONTROLLEDCOMMITTEE7
r l~„~,~,~ ~ YES ^ NO
ADDRESS (NO P.O. BOX)
I~ 7 GV 'Y~~~nJ~
CITY STATE ZIP CODE AREA CODEIPHONE
G~~~ ~ ~~ ~~ Aso I a
COMMITTEE NAME
NAMEOFTREASURER
NUMBER
CONTROLLED COMMITTEE?
^ YES ^ NO
COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX)
CITY STATE ZIP CODE AREACODEIPHONE
NAME OFBALLOTMEASURE
BALLOTNO.ORLETTER (JURISDICTION
COVERPAGE•PART2
^ SUPPORT
^ OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD
DISTRICT N0. IF ANY
Primarily Formed CandidatelOfficeholderGommittee List names of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT
^ OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (January105)
FPPC Toll•Free Helpline; 8661ASK•FPPC (8661276.7772)
State of California
Campaign Disclosure Statement
Summary Page
Type or print in ink.
Amounts may be rounded
to whole dollars.
from o7/0l/2009
SEE INSTRl1CTIDNS ON REVERSE
through 12/31/2009 I Page 3 of 7
NAME DF FILER
Dolly Sandoval for Supervisor-Debt Retirement Committee
Contributions Received
1. Monetary Contributions ........................................... ScneduieA,line3 $
2. Loans Received ...................................................... scneduie e, Line 3
3. SUBTOTALCASHCONTRIBUTIONS ......................... Add lined+2 $
4, NonmonetaryContributions .................................... Scneduiec,line3
5. TOTALCONTRIBUTIONSRECEIVED ••.•••••.•••,••••••••••••••Addlines3+4 $
Column A
TDTALTHISPERIDD
(FRDMATTACHEDSCHEDULEa)
$83,974.45 $
Statement covers perlod
SUMMARYPAGE
I.D. NUMBER
990787
Column B Calendar Year Summary for Candidates
OJOTALDTO WT~ER Running in Both the State Primary and
General Elections
$83,974.95
-$110,000.00 $O.oO
-$26,025.55 $ $83,974.45
$o.oo $o.oo
-$26,025.55 $ $63,974.45
Expenditures Made
8. Payments Made ....................................................... scneduieE,Lineq $ $o.oo
7. Loans Made ............................................................. scheduieH,line9 So.oo
8. SUBTOTALCASHPAYMENTS ................................. ... AddLiness+~ $ $o.oo
9. Accrued Expenses (Unpaid Bills) ............................ ...scneduie F,Line9 $o.oo
10.NonmonetaryAtljustment ........................................ ..schedulec,line3 So.oo
11. TOTALEXPENDITURESMADE ................................ Adduneae+s+to $ So.oo
$ $o.oo
$o.oo
$ $0.00
$o.oo
So.oo
$ $o.oo
Current Cash Statement
12, Beginning Cash Balance ....................... Previous summary Page, Linels $ $26,o19.6e
13. CashReceipfs ................................................... coiumnA,line3adove -$26,025.55
14, Miscellaneous Increases to Cash ........................... scneduiel, Lineq $5.67
15. Cash Payments .................................................. column A,linesaaove $o.oo
16. ENDING CASH BALANCE ........., Add Lines 12 + 13 + tq, then subtract fa'ne 15 $ S o . 00
h this is a termina6'on statement, Line 16 must be rero.
17.LOANGUARANTEESRECEIVED ........................... schedule e,Pan2 $ So.oo
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ Sae insWctions on reverse $ $o . 00
19. OUtStanding DebtS ......................... AddLine2+Line9inColumnBa6ove $ So.oo
To calculate Column B, add
amounts in Column A to the
corresponding amounts
from Column B of your last
report. Some amounts in
Column A may be negative
figures that should be
subtracted hom previous
period amounts. If this is
the first report being filed
', for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (ii
~I any).
111 through 6130 711 to Dete
20, ConMbutions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
tnSu6lect to VoluMery Expendnure LJma)
Date of Election Total to Date
(mmlddlyy)
~_~ $
_I_J $
*Amounts in this section may be different from amounts
reported in CDlumn B.
FPPC Form 480 (January108)
FPPC Toll•Free Helpline: 8881ASK-FPPC (8881178.9772)
chedule A Type or print in Ink, SCHEDULE A
Monetary Contributions Received ^~~~~~~~~ ,,,ny ue ruunaea Statement covers period
to whole dollars, ~ ~ •, ~ ~
'
from 07/01/2009 ,
~
SEE INSTRUCTIONS ONREVERSE through 12/31/2009 Page 4 of 7
NAME OF FILER
Dolly Sandoval for Supervisor-Debt Retirement Committee
I.D. NUMBER
990787
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION
RECEIVED QFCOMMITTEE,ALBOENTERI.D.NUMBER)
CODE * OCCUPATIONANDEMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE
QFBELF•EMPLOYED,ENTERNAME PERIOD
(JAN.1-DEC, 31)
(IF REQUIRED)
OFBU&INEBB)
12/31/2009 Ms. Dolores Sandoval
BIND Councilmember
$15,000.00
$83,979.45
10720 Alderbrook Lane ~~OH City of Cupertino
Cupertino CA 95019 Q PTY
OSCC
12/31/2009 Ma. Dolores Sandoval
®IND Councilmember
$10,000.00
$83,974.45
10720 Alderbrook Lane ~~OH City of Cupertino
Cupertino CA 95014 ^ PTY
SCC
12/31/2009 Ms. Dolores Sandoval ®IND Councilmember
$40,000.00
$83,974.45
10720 Alderbrook Lane ~n~u City of Cupertino
Cupertino CA 95014 0 PTY
SCC
12/31/2009 Ms. Dolores Sandoval BIND Councilmember $18,974.45 $83,974.45
10720 Alderbrook Lane D SOH City of Cupertino
Cupertino CA 95014 ~FTY
SCC
BIND
~COM
BOTH
Q PTY
OSCC
SUBTOTALS $83,974.45
Schedule A Summary
Amount received this period- itemized monetary contributions.
(Include all Schedule A subtotals.) ........................................................................................................ $ $83, 979.45
2. Amount received this period- unitemized monetary contributions of less than $100 ............................. $ so. 00
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ $a3, 974.45
*Contdbutor Codes
IND-Individual
COM - Reapient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY- PDlitical Party
SCC - Small Contributor Committee
FPPC Form 460 (January105)
FPPC Toll•Free Helpline: 8661ASK•FPPC (8681275.3772)
,~e „ .,.r.,e ~., r.~
SCHEDULER-PART1
5cneaule l3 -Part 1 '"" "' ~""- "' """
Amounts may be rounded
Statement covers period
•
Loans Received to whole dollars. ~ s
~ J ~
from 07/01/2009 ~'
SEE INSTRUCTIONS ONREVERSE through 12/31/2009 page 5 of 7
NAME OF FILER I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990787
FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT kl
AMOUNTPAID OUTS A DING INTEREST ORIGINAL CUMULATIVE
OF LENDER
QFCOMMnTEE
ALSOENTERLD
NUMBER)
(IF6ELF•EMPLOYED,ENTER BALANCE
BEGINNING THIS
RECEIVED THIS
OR FORGNEN BALANCEAT
CLOSE OF THIS
PAID THIS
AMOUNT OF
CONTRIBUTIONS
,
. NAMEOFBUSINE6S) PERIOD THIS PERIOD" PERIOD LOAN TO DATE
Ms. Doloree Sandoval Councilmember
PAID CALENDAR YEAR
City of Cupertino Szo,ooa.ao
i So.oo
S
% $20,000.00
S $e3,974.45
S
10720 Alderbrook Lane ^FORGIVEN -
RaTE PERELECTION*'
Cupertino CA 95014 S2o,oo0.0o $0.00 09/30/1999
S S S S S
t® IND ^ COM ^ OTH ^ PTY ^SCC DATEDUE DATE INCURRED
Me. Dolores Sandoval Councilmember
®PAID CALENDARYEAR
City of Cupertino $6,025.55 $0.00 $25,000.00 $83,914.45
S S % S S
10720 Alderbrook Lane ®FGRGIVEN -
RATE PER ELECTION "*
Cupertino CA 95014 $ $25, D00.00 S $0.00 s $18,974,45 $ 02/29/2000 s
t~
'U iIYD ^ INIVI ^ GIH ^ PII ^ JW un,~uu~ DATE IiY1.URItCG
Me. Dolores Sandoval Councilmember ^PAID CALENDARYEAR
City of Cupertino So.oo $40,000.00 563,974.45
S S % S S
10720 Alderbrook Lane ®FGRGIVEN -
RATE PERELECTIDN*
Cupertino CA 95014 S S4o,oo0.0o S So.oo S $40,000,00 S 11/06/2000 S
t® IND ^ COM ^ OTH ^ PTY ^SCC DATEDUE DATEINCURRED
SUBTOTALS $ Sa.oo$ $es,ooo.oo$ $o.oo$ $o.oo
Schedule B Summary
1, Loans received this period ....................................................................................................................$ so.oo
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, $ SllO, ooo. 00
(Total Column (c) plus loans under $100 paid orforgiven,)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Netchangethisperiod. (SubtractLine2fromLine1.) ............................................................... NET $ -Sllo,ooo.oo
Enter the net here and on the Summary Page, Column A, Llne 2. (Mey beenegelive number)
"Amounts forgiven or paid by another party also must be reported on Schedule A.
"* If required.
(EMer(e) on
Schedule E, Llnez)
tContdbutor Codes
IND-Individual
COM - Reapient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY-Political Party
SCC-SmallContdbutorCommiltee
FPPC Form 460 (January105)
FPPC Toll-Free Heipline: 6661ASK•FPPC (8661175'3772)
_ V _ J..1 _ A '. _ ~.. Tilnn nr nrlnf in In4 SCHEDULE B-PART 1
A7rr11Cl1U1C D -raft 7 Amounts may be rounded Statement covers period
Loans Received to whole dollars, '' 4 ~ I
from o7/0l/2009 ~'
SEE INSTRUCTIONS ONREVERSE through 12/31/2009 page 6 of 7
NAME OF FILER
I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990797
FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING Ibl
AMOUNT (c(
OUTS A DING e p
OF LENDER OCCUPATIONANDEMPLOYER
BALANCE
RECENED THIS AMOUNTPAID
BALANCEAT INTEREST ORIGINAL CUMULATNE
(IFCDMMnTEE,AISOENTERI.D.NUMBER) (IFSELF•EMPIAYED,ENTER BEGINNING THIS
PERI OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS
NAMEDFBUBINESS( OD THIS PERIOD` PERIOD LOAN TO DATE
Me, Dolores Sandoval Councilmember
^ PAID CALENDARYEAR
City of Cupertino $O. Bn $10,000.00 $83,974.45
S 6 -% S S
10720 Alderbrook Lane anrE
OFORGIVEN PERELECTION*
Cupertino CA 95014 = Sio,ooo.oo S So,oo 3 Sio,ooo.oo E 11/13/2000 =
® IND ^ COM ^ OTH ^ PTY ^SCC DATEDUE DATE INCURRED
Me. Dolores Sandoval Councilmember
^ PAID CALENDAR YEAR
City of Cupertino S s So.oo % Sie,aoo.oo
S Se9,9Ta.9s
S
10720 Alderbrook Lane -
anrE
® FORGIVEN PER ELECTION *
Cupertino CA 95014 ' Sis,ooo.oo = So.oa $ S> ,000.00 11/19/2000
t~ IND n COM n OTH rl PTY rl SCC
nnrcnnc S s
^ PAID CALENDAR YEAR
3 S % S S
_
^ FORGIVEN RAre PER ELECTION *
3 S S
t^ IND
^ COM ^ OTH ^ PTY ^SCC
DATE DUE 3
DATE INCURRED =
SUBTOTALS $ So.oo$ Ss9,ooo.ou$ So.oo$ So.oo
Schedule B Summary
1, Loans received this period ....................................................................................................................$ So.oo
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid orforgiven this period ......................................................................................................... $ Sllo, ooo. ao
(Total Column (c) plus loans under $100 paid orforgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Netchange this period. (Subtract Line 2 from Line 1, -Silo, ooo. 00
............................................................ NET $
Enter the net here and on the Summary Page, Column A, Llne 2. (Mey beenepetive number)
`Amounts forgiven or paid by another party also must be reported on Schedule A.
" If required.
(Emer (el on
Schedule E, Lme 3)
tContributor Caries
IND-Individual
COM - Reapient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY-Political Party
SCC -Small Contributor Committee
FPPC Form 460 (January105)
FPPC Toll•Free Hetpline: 8661A8K•FPPC (86612r5~172)
Schedule I Tvna nr nrinf in in4 CCNFnI II G I
Miscellaneous Increases to Cash Amounts may be rounded
to whole dollars,
SEE INSTRUCTIONS ON REVERSE Statementcovereperiod
from 07/01/2009
through 12/31/2009
~ 5 ~ I ~ '
~
page 7 of 7
NAME OF FILER
Dolly Sandoval for Supervisor-Debt Retirement Committee
I.D,NUMBER
990787
DATE
RECEIVED FULLNAMEANDADDRESSOFSOURCE
QF COMMITTEE,ALSO ENTER I.O. NUMBER)
DESCRIPTION OF RECEIPT AMOUNT OF
INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets.
SUBTOTALS
Schedule I Summary
1. Itemized increases to cash this period ........................................................................................................................ $ so. 00
2. Unitemized increases to cash of under $100 this period ............................................................................................. $ $s. a7
3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ................................. $ so. 00
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) ........................................................................................................................... TOTAL $ ss. R7
FPPC Form 460 tJanuary105)
FPPC Toll•Free Helpline: 8661ASK-FPPC 15661275.3772)